CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2 The Use of Health Information Technology in Physician Practices

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes When you finish this chapter, you will be able to: 2.1Describe the functions of practice management programs. 2.2Identify the core functions of an electronic health record system. 2.3Discuss the advantages of electronic health records. 2.4Describe the impact of health information technology on documentation and coding. 2.5Discuss how the HIPAA Privacy Rule and Security Rule protect patient health information. 2.6Explain how the measures put in place by the HITECH Act strengthen HIPAA privacy and security requirements. 2-2

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms administrative safeguards audit/edit report audit trail autoposting breach clearinghouse CMS-1500 (08/05) computer-assisted coding electronic data interchange (EDI) 2-3 electronic funds transfer (EFT) electronic medical records (EMRs) electronic prescribing evidence-based medicine health information technology (HIT) HIPAA (Health Information Portability and Accountability Act of 1996)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms (Continued) HIPAA Electronic Transaction and Codes Sets standards HIPAA Privacy Rule HIPAA Security Rule HITECH (Health Information Technology for Electronic and Clinical Health Act) National Provider Identifier (NPI) 2-4 personal health records (PHRs) physical safeguards protected health information (PHI) technical safeguards walkout statement workflow X Health Care Claim (837P)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.1 Functions of Practice Management Programs 2-5 Health information technology (HIT) is a term used to refer to the computer hardware, software, and networks that are used to record, store, and manage patient health care information

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.1 Functions of Practice Management Programs (Continued) 2-6 Most offices use a practice management program (PMP) to complete routine office tasks, including: –Patient scheduling –Recording patient information –Creating and transmitting electronic claims –Receiving electronic payments –Billing patients –Creating financial reports –Collecting on overdue accounts

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.1 Functions of Practice Management Programs (Continued) 2-7 A clearinghouse is a company that collects electronic insurance claims from medical practices and forwards the claims to the appropriate health plans An audit/edit report is sent from the clearinghouse to the practice, after the basic edit is complete

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.1 Functions of Practice Management Programs (Continued) 2-8 Reimbursement –A walkout statement lists the procedures performed, the charges for the procedures, and the amount paid by the patient –Autoposting is an automated process for entering information on a remittance advice (RA) into a computer

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.2 Functions of Electronic Health Record Programs 2-9 Electronic medical records (EMRs) are computerized records of one physician’s encounters with a patient over time Personal health records (PHRs) are private, secure electronic files that are created, maintained, and owned by the patient Electronic prescribing is the use of computers and handheld devices to transmit prescriptions to pharmacies in digital format

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.2 Functions of Electronic Health Record Programs (Continued) 2-10 Electronic health records (EHRs) may include information from multiple EMRs and have eight core functions: 1.Health information and data elements 2.Results management 3.Order management 4.Decision support 5.Electronic communication and connectivity 6.Patient support 7.Administrative support 8.Population reporting and management

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.3 Advantages of Electronic Health Records 2-11 Advantages of EHRs include: –Increased patient safety –Improved quality of care –Greater efficiency

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.3 Advantages of Electronic Health Records (Continued) 2-12 Evidence-based medicine refers to medical care that uses the latest and most accurate clinical research in making decisions about the care of patients The Health Information Technology for Economic and Clinical Health Act (HITECH) is intended to promote the use of EHRs in physician practices and hospitals through the use of financial incentives

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.4 The Impact of HIT on Documentation and Coding 2-13 A Workflow is a set of activities designed to produce a specific outcome The process of assigning preliminary diagnosis and procedure codes with a computer is known as computer-assisted coding

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.4 The Impact of HIT on Documentation and Coding (Continued) 2-14 Impact of HIT on Documentation and Coding –Every service must be documented in order to receive reimbursement –Incomplete or incorrect documentation may result in claim denials or even a federal investigation –All codes should be reviewed to ensure accuracy

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.5 HIPAA Legislation and its Impact on Physician Practices 2-15 The Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains a number of rules, including: –HIPAA Electronic Transaction and Code Sets standards –HIPAA Privacy Rule –HIPAA Security Rule –Final Enforcement Rule

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.5 HIPAA Legislation and its Impact on Physician Practices (Continued) 2-16 HIPAA Electronic Transaction and Code Sets standards –Describe an electronic format that providers and health plans must use to send and receive health care transactions –The electronic transmission of data is called electronic data interchange (EDI) –Payment may be via electronic funds transfer (EFT)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.5 HIPAA Legislation and its Impact on Physician Practices (Continued) 2-17 Claim Formats –The HIPAA-standard X Health Care Claim, or 837P –The CMS-1500 (08/05) paper claim The National Provider Identifier (NPI) is a ten- position numerical identifier consisting of all numbers

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.5 HIPAA Legislation and its Impact on Physician Practices (Continued) 2-18 HIPAA Privacy Rule –Protects individually identifiable health information –Mandates rules all covered entities must follow in protecting patients’ privacy –Information that can be used to find out a person’s identification, is referred to as protected health information (PHI)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.5 HIPAA Legislation and its Impact on Physician Practices (Continued) 2-19 HIPAA Security Rule –Outlines safeguards to protect health information stored on a computer system or transmitted across computer networks –Administrative safeguards: the policies and procedures that protect electronic health information –Physical safeguards: the mechanisms required to protect electronic systems, equipment, and data –Technical safeguards: the automated processes used to protect data and control access to data An audit trail is a report that shows who has accessed information and when

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.5 HIPAA Legislation and its Impact on Physician Practices (Continued) 2-20 HIPAA in the Age of Health Information Technology –A breach is the acquisition, access, use, or disclosure of unsecured PHI in a manner not permitted under the HIPAA Privacy Rule

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2.6 The HITECH Act’s Impact on Privacy and Security 2-21 The HITECH Act introduced additional privacy and security regulations, including: –Breach notification –Monetary penalties –Advanced enforcement